LGBTQ couples experience conflict when deciding between known and unknown sperm donors
Understanding the decision-making process of LGBTQ couples choosing between a known versus unknown sperm donor (McCormick, 2025)
McCormick, N. M. (2025). Understanding the decision-making process of LGBTQ couples choosing between a known versus unknown sperm donor [Doctoral dissertation, Clark University]. https://www.proquest.com/openview/a4a114255654b2d39c37e50ddeb692fa/1
Geographic Region: United States
Research Questions:
How much decisional conflict do LGBTQ couples experience when choosing between a known versus unknown sperm donor?
What do LGBTQ couples find most difficult about this decision, and what resources would help them?
What role do emotion regulation skills, decision-making style, and relationship intimacy play in the decision-making process?
Are there meaningful differences between cisgender couples and couples that include one or more transgender or nonbinary people?
Editor’s Note: This study uses the terms “known donor” and “unknown donor.” The American Society for Reproductive Medicine (ASRM) now prefers “directed donor” (or “identified donor”) and “nonidentified donor” respectively. DCJC uses the study’s original language in this summary to accurately represent the research, but readers should be aware that preferred terminology in clinical and professional settings is shifting.
Design: Mixed-methods needs assessment that combined an online survey with individual semi-structured interviews. Data collection occurred from November 2023 to June 2024. Online surveys measured how much uncertainty couples felt about their decision, how well they could manage their emotions, how close they felt to their partner, and what style they used when making decisions. After the surveys, each partner was interviewed separately to talk about their experience making this decision. The researcher analyzed the survey data using statistical methods that account for the fact that both people in a couple are connected to each other. The interview data was analyzed to find common themes and understand the deeper meaning of couples’ experiences.
Sample: 50 people forming 25 couples who identified as LGBTQ and were either currently deciding between a known and unknown sperm donor or had recently made this decision without yet having children. Everyone in the study had at least some college education, and most couples (68%) included one or two people with graduate degrees. All couples except one were from middle- or high-income backgrounds. Nine (36%) included one or two people of color, 13 (52%) included one or two transgender or non-binary individuals, and 21 (84%) included one or two non-lesbian individuals. Most couples had already made their donor decision by the time they joined the study and said they were unlikely to change their minds. At the time of the study, there were no instances of a couple disagreeing about their chosen donor route (although some had disagreed at previous points in the decision-making process). The research team purposefully recruited approximately equal numbers of couples interested in using a known donor (N=13) versus an unknown donor (N=12). Participants were recruited between October 2023 and April 2024 via Facebook, Reddit, professional contacts, and snowball sampling.
Key Findings
How much decisional conflict do LGBTQ couples experience when choosing between a known versus unknown sperm donor?
Editor’s Note: 88% of participants (22 of 25 couples) had already made their donor decision before completing the survey and interview. Only 3 couples were still actively deciding. This means that for most participants, the decisional conflict scores and interview responses reflect retrospective accounts of a process they had already completed not real-time experience.
Overall, 54% of participants (27 of 50) reported feeling moderate to high uncertainty when deciding between choosing a known or unknown donor.
Nearly half of the couples (12 of 25) were "discordant," meaning partners reported meaningfully different levels of decisional conflict from each other. Partners reporting higher conflict tended to have felt less certain about wanting to be a parent, arrived at the decision later, or described themselves as temperamentally more indecisive.
People who looked back and said the decision felt hard (i.e., had high decisional conflict) were also more likely to report struggling with emotional regulation and putting decisions off than participants with low or moderate decisional conflict. These findings were statistically significant.
What do LGBTQ couples need to make this decision easier?
Almost every couple (92%) said they didn’t have enough information. They lacked knowledge about donor options themselves (many had never heard of known donors), the costs, legal implications, long-term implications, and medical aspects of each choice. Many wanted to hear the perspectives of donor-conceived people to better understand their options.
Most couples (88%) struggled with limited informational, emotional, and financial resources. They couldn’t find websites, articles, books, or healthcare professionals explaining the donor decision process. Research was often behind academic paywalls and written in technical language. Many lacked LGBTQ friends or family who could offer guidance. Resources were designed for straight couples dealing with infertility, not for LGBTQ couples experiencing joy in family building or grief over losing privacy and autonomy (not grief over infertility). Some couples couldn’t afford sperm banks, limiting their choices.
About half of couples (52%) struggled to figure out how much weight to give different factors. Many couples struggled with how to weigh competing considerations (e.g., wanting their child to appear physically like both parents vs. wanting a known donor on principle; or valuing a child’s access to biological origins from birth vs. concerns about the complexity of an ongoing known donor relationship). For interracial couples, decisions about donor race were often emotionally fraught.
Some couples (32%) felt overwhelmed by how many additional decisions were embedded in the initial choice. Choosing an unknown donor meant deciding which sperm bank to use, what donor characteristics matter, anonymous versus identity-release, how much to spend, how many vials to buy, and whether to join sibling registries. Choosing a known donor meant deciding where to find them, who to ask and how, what role they’ll play, legal protections, insemination methods, genetic testing, and who to tell about the arrangement.
Some couples (24%) believed there had to be one “correct” choice with no negative consequences. Their search for the perfect answer led to procrastination or obsessive research, which frustrated their partners. These participants often struggled with anxiety about doing things “right” in life generally.
Couples identified seven types of support they wanted:
All 25 couples wanted a better understanding of both options and their implications before making a decision.
Most couples (20 of 25) wanted to hear how other couples made this decision.
Most couples (15 of 25) sought out donor-conceived people’s perspectives online and found them influential (both validating and alienating). Participants wanted a balanced, contextualized presentation of DCP perspectives and noted that many DCP who advocate most strongly for known donation were raised by heterosexual parents who deceived them about their conception.
Many couples (10 of 25) wanted prompts to help them identify what mattered most to them and structure difficult conversations with their partners. Several wished they'd had something similar to what couples therapy offered.
Some couples (8 of 25) wanted validation that this decision is difficult and that there’s no wrong choice.
Several couples (7 of 25) felt uncertain about the role of the non-gestational/non-genetic partner in the decision-making process and wanted explicit encouragement to assert their preferences.
Most participants of color (9 of 12) wanted preparation for the reality that finding a donor of a specific race or ethnicity might be difficult, potentially requiring them to choose a donor route they hadn’t preferred. Interracial couples described needing support to have explicit, values-driven conversations about the significance of race in their future child's identity.
How do personal factors (emotions, decision-making style) and relationship factors (closeness) affect their decision-making?
Most correlations between decisional conflict and intimacy, decision-making style, and emotion regulation were not statistically significant in the full sample, which the author attributed primarily to the small sample size. Trends generally moved in expected directions: higher decisional conflict trended with lower intimacy, greater emotion regulation difficulties, and greater use of non-adaptive decision-making styles (procrastination, buck-passing).
In the qualitative interviews, participants reflected back on how emotions and relationship dynamics had shaped their decision-making process. Participants described emotions as double-edged, helpful when they provided information about values (e.g., an “ick” reaction to a specific donor type that clarified preferences), and harmful when they became overwhelming and led to avoidance or delayed decision-making. Several couples reported using individual or couples therapy specifically to process emotions related to the donor decision. Couples who could speak honestly with each other about vulnerability-inducing topics described navigating the decision more smoothly, while those who struggled to “get on the same page” described confusion, hurt feelings, and delays.
The study also identified a common dynamic in which one partner (the “initiator”) drove the information-gathering process while the other (the “follower”) engaged later, sometimes creating resentment or misalignment. Couples fared better when both partners were engaged with information from approximately the same starting point.
What differences in the decision-making process exist between cisgender couples and couples in which one or both members identify as trans or nonbinary?
Trans and nonbinary participants (n=15) reported similar overall levels of decisional conflict to their cisgender counterparts, but were more likely to lack tools for managing their emotions when upset (statistically significant).
Two main needs emerged from interviews: (1) help sorting through strong emotions and conflicting values about choosing a known donor, and (2) resources that acknowledge unique challenges (like gender dysphoria) and strengths (like expansive ideas of family).
Some trans and nonbinary participants strongly disliked when partners suggested using a known donor. They worried about having a “masculine” person in their child’s life who wasn’t them. They feared not being seen as their child’s “real dad” or feeling less masculine. Some resolved this by choosing more distant known donors or preferring gay, genderqueer, or effeminate donors because they felt less threatened. One opposing view: Some nonbinary participants wanted a cisgender male presence to give their child positive masculine role models, especially since they had few cisgender men in their lives.
Some gender-minority participants wanted known donors because it felt “more queer” (less like straight couples) and built community. This came up less often among cisgender couples.
Some trans participants described dysphoria arising during the donor decision-making process itself, particularly when confronting physical limitations of their bodies (e.g., inability to impregnate a partner). For some, this slowed their engagement with the process.
Some trans men and masculine-presenting nonbinary people described concerns about the donor decision revealing their gender identity to people who did not already know, particularly if using a known donor meant regular contact with someone in their community.
Several trans men noted that available resources about trans parenthood were predominantly cautionary or trauma-focused, failing to reflect the excitement and gender-affirmation many felt about becoming a father.
Two participants described having had to disavow interest in having children as adolescents in order to access gender-affirming care, and were still processing the psychological complexity of now pursuing parenthood.
Limitations: The sample was mostly white, highly educated, and all but one couple identified as middle or high income. Most couples had already made their decision at the time of recruitment (22 of 25 couples). Decisional conflict scores and qualitative accounts of the decision-making process reflect retrospective reconstruction, not real-time experience. People who have settled on a choice tend to reframe their prior uncertainty in ways that make their decision feel more coherent and less fraught than it was at the time, a well-documented phenomenon in decision research sometimes called “choice-supportive bias.” The quantitative sample was small, limiting statistical power and the ability to conduct subgroup analyses or mediation analyses. Correlations should be treated as general estimates of association rather than definitive findings. The Decisional Conflict Scale was originally developed for medical decisions (e.g., cancer treatment choices). It has not been validated specifically for family-building decisions among LGBTQ people.
Applications: Therapists working with LGBTQ couples should recognize that decisional conflict around donor choice is common and that addressing emotion regulation skills, communication patterns, and decision-making styles can support couples through this process. Mental health professionals should be prepared to help transgender and nonbinary clients process complex emotions, including gender dysphoria, concerns about gender identity in relation to parenthood, and fear of being outed. Professionals can also validate that becoming a parent can be a joyful and gender-affirming process for transgender and nonbinary people.
Funding Source: Not explicitly stated
Lead Author: Nora McKillop McCormick earned her PhD in Psychology from Clark University in August 2025, where she worked in Dr. Abbie Goldberg’s Diverse Families and Sexualities Lab. Her research focuses on LGBTQ family formation, adoption, donor conception, and supporting diverse families through decision-making processes. No personal connection to donor conception was disclosed.
Regulatory Context
The United States has no comprehensive federal legislation governing donor conception, with regulation primarily occurring at state level, creating a patchwork of laws across the country. The Food and Drug Administration (FDA) provides minimal federal oversight, mainly focused on screening requirements for disease prevention.
There are no federally mandated limits on the number of children conceived from a single donor. The American Society for Reproductive Medicine (ASRM) recommends limiting donors to 25 live births per population area of 850,000, but this is voluntary and not enforced. Colorado became the first state to establish a statutory limit in 2022, capping donor use at 25 families per donor, regardless of location, effective January 2025.
No centralized national registry exists to track donor-conceived births OR donors, making it difficult to enforce any limits in practice.
Commercial donation is permitted throughout most of the United States. Donors can be compensated for their gametes.
Access to donor conception is generally open to a wide range of individuals regardless of marital status, sexual orientation, or gender identity. Most major medical organizations support the position that fertility treatments should be available to any individual who is fit to parent.
The U.S. does not have national laws prohibiting anonymous donations, but this practice is gradually changing. Colorado’s 2022 “Donor-Conceived Persons Protection Act” (effective January 2025) bans anonymous donation and gives donor-conceived individuals the right to access their donor’s identity upon reaching age 18. In January 2024, the Uniform Law Commission amended the Uniform Parentage Act to require disclosure of donor identifying information to adult donor-conceived persons upon request, though states must adopt this amendment for it to become law in their jurisdictions.
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